Elder Abuse – making the connection

I’ve often raised the connection between the growing problem of Elder Abuse and the risks of coercion and abuse that this phenomenon presents if euthanasia and/or assisted suicide are ever legalised. To say that Euthanasia and Assisted Suicide may well provide the opportunity for the ultimate in Elder Abuse is very real and an example of the long held argument that E & AS laws abandon the vulnerable in our community.

Though the connection seems obvious to me, some have tried to dismiss it either arguing that Elder Abuse is not necessarily as large a problem as we suggest or by simply denying any possible connection.

The reality of the problem is beyond any doubt as a recent SKYNEWS report makes clear. Professor Wendy Lacey, the Dean of Law at the University of South Australia told SKY, 'This is the next wave of a vulnerable group of people being neglected or abused on a very wide scale.'

'The research we do have suggests that two to five per cent of all people aged over 65 have experienced some form of abuse. We also know it's likely to be very much under reported,' she says.

The report quotes Greg Mahney, chief executive officer of Advocare, an independent, community-based organisation that works to protect the rights of older West Australians. His organisation deals with about 500 cases of elder abuse each year, and he believes that's just the tip of the iceberg.

'It can take people years to first of all accept that their loved ones - the son or daughter they have raised, with all their values - is actually doing them harm. And it can take years for people to then come forward and want to do something about it, or even tell anyone else about it,' he says.

It is a silent epidemic. Either the abused person is so socially isolated that they have no way to report the abuse or they live in fear of speaking out.

Professor Lacey says that, 'The research we do have suggests that two to five per cent of all people aged over 65 have experienced some form of abuse. We also know it's likely to be very much under reported,' she says.

Elder Abuse can take any form from coercion the financial, physical, emotional and even sexual manipulation and abuse. As I said earlier, the connection to euthanasia and assisted suicide should be quite obvious: any person who has been emotionally manipulating an elderly person may well be able to pressure such a person into asking. In Oregon, where it is not necessary for a doctor to be present when a person ingests the lethal suicide drugs, the risks are extreme.

But don’t take my word for it; consider a report last week from the Financial Post. In an article entitled: Why you shouldn’t overlook the financial implications of doctor-assisted suicide, special Canadian reporter and expert in aging issues, Lee Anne Davies reflects upon the recent Supreme Court decision and warns that ‘While it’s most likely that the new legislation regarding death with dignity will include wording that ensures informed consent and no coercion, there can be still be bedside influences.’

Davies provides a number of scenarios concerning financial pressures that might lead to subtle coercion of the elderly person concerning their decisions. Some are likely not relevant in Australia where a lack of health insurance is unlikely to be a barrier to good care.

‘For some families, the unforeseen health-related expenses or loss of income for a family caregiver drain the family’s finances rapidly, leaving very little money for the surviving spouse. The ailing partner might deliberately choose to die sooner, arguing that they were in the last months of life anyway.

‘Conversely, the dying spouse might not be fully at ease with the decision but he or she is influenced by a spouse who is afraid to be left penniless. The surviving spouse may not openly suggest assisted suicide but their stress about finances is apparent. This isn’t an overt case of financial abuse, but a grey zone. The couple shares the plight of a dire financial future and the sick spouse believes he or she is doing the right thing.’

Davies acknowledges that any law arising out of the Supreme Court decision would look to apply safeguards relating to coercion and free and informed consent. She warns, however, that, ‘The potential for laws on physician-assisted suicide, whether provincial or federal, to be drafted over the next year may lull people into a false sense of control over matters occurring at the end stages of life.’

Davies restricts her comments to abuse for financial gain. But that is not the only risk that elderly people face in terms of euthanasia and assisted suicide. Palliative Care Specialist, Dr Paul Dunne AM says that requests for an ‘early death’ in his experience most often come from relatives. For whatever reason, if relatives can make such a suggestion directly to the physician, how more likely are they to suggest the same outcome to their ailing relative if euthanasia and assisted suicide are an available option?

Elder suicide is already a significant problem in Australia. A recent euthanasia-promotion article in AusPharmList put the rate at four suicides per week amongst people over 70 years of age. But rather than asking for better intervention services and rather than trying to understand this statistic, Dr Rodney Syme, as others have before, tries to use these statistics to argue for euthanasia law.

“The tragedy is not that these people take their own lives; it is how they are compelled to do it in the absence of compassionate legislation permitting medical advice and assistance.” Says Syme. Compelled? Really? Suicide, not a tragedy? This is dangerous and errant thinking.

Research in Oregon points to the reality that fear of pain is a lower order concern for those who have availed themselves of their suicide laws. The highest concerns are loss of autonomy and the inability to do the things that they enjoy. These are essentially existential problems that can and should be dealt with by skilled medicos and support staff.

But, you see, this is somehow all our fault for opposing euthanasia and assisted suicide; ours and those stubborn politicians who won’t ‘get with the program.’ Statistics are just numbers, but behind every number on suicide is a human tragedy.

Even if, for some, suicide is lauded as ‘heroic’ or ’brave’ as it was by the media in the Brittany Maynard case, we have to ask what effect the characterisation of suicide in this way will have on others who face the same or similar conditions. Should they be ‘brave’ like Maynard? These pressures, though subtle, may be very real – just as with Elder Abuse.

Even to suggest that the elderly should be able to resort to suicide as a legal way out is akin to saying, in some circumstances, that we really don’t care. Whether intended or not, it is precisely the same kind of message that an abused elderly person senses from their abuser. Are Syme and others simply using the elderly as cannon fodder for their own ends? Even if they have some genuine concern for the elderly theirs is not a compassionate answer.